舌骨位置对预测阻塞性睡眠呼吸暂停低通气综合征腭部手术疗效的作用

Effects of hyoid position on surgical treatment outcome for patients with obstructive sleep apnea hypopnea syndrome

目的 研究阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者舌骨位置在改良腭咽成形术联合软腭前移术治疗中的预测作用.方法 2008年7月至201 1年12月期间对128例经多道睡眠呼吸监测确诊的OSAHS患者术前行纤维喉镜检查,均存在腭咽部狭窄.行清醒平静呼气末上气道CT扫描,测量舌骨下缘距下颌骨下缘的垂直距离（the vertical distance between inferior margin of hyoidto the inferior mandibular margin,D-HM）等CT参数.所有患者均行改良腭咽成形术,其中92例联合软腭前移术.术后6个月复查多道睡眠监测.结果 128例患者均为男性,年龄19 ～ 66岁,平均（x±s表示,以下同）（39.6±8.5）岁.睡眠呼吸暂停低通气指数（AHI）由术前（58.2±22.4）次/h改善至（20.6±18.1）次/h（=14.9,P＜0.001）,其中手术有效77例（60.2％）,无效51例（39.8％）.比较有效与无效两组患者之间的术前各参数后发现,有效组和无效组患者的D-HM分别为（14.6±7.7）mm和（19.4±8.0）mm,差异有统计学意义（t=3.452,P=0.001）,Logostic回归分析显示D-HM、术前AHI及夜间最低血氧饱和度是影响手术疗效的独立因素（P值均＜0.05）.D-HM与术后残余AHI有显著相关性（r=0.284,P=0.001）.D-HM≥23 mm时,判断术后AHI＞ 10次/h的特异度为95.2％.结论 D-HM是影响OSAHS患者手术疗效的独立因素,D-HM≥23 mm的OSAHS患者不适合腭部手术的治疗。

Objective To evaluate the predictive value of the position of the hyoid in surgical outcomes of velopharyngeal surgery for obstructive sleep apnea hypopnea syndrome （OSAHS）.Methods The polysomnography,CT,and anthropometry data were retrospectively reviewed from patients who underwent revised uvulopalatopharyngoplasty with uvula preservation （H-UPPP） simply or the combination of H-UPPP and transpalatal advance pharyngoplasty （TAP） for OSAHS from July 2008 to December 2011.OSAHS was diagnosed by polysomnography（PSG） in 128 patients who underwent H-UPPP or H-UPPP with TAP surgery for their sleep disorder.After surgical treatment,the patients were evaluated by PSG.Results The 128 patients included were all male,the mean age of these patients was （39.6-± 8.5） years,ranged from 19 to 66 years.Seventy-seven patients were successfully treated and 51 did not respond to surgical treatment.The overall apnea hypopnea index （AHI）improved from （58.2-± 22.4）times/h preoperatively to （20.6 ± 18.1）times/h postoperatively （t =14.9,P 〈 0.001）.The vertical distance from inferior margin of hyoid to the inferior mandibular margin （D-HM） was the only parameter that had a significant difference between responders [（14.6 ± 7.7） mm] and non-responders [（19.4± 8.0） mm] （t =3.452,P =0.001）.D-HM,AHI and the lowest blood oxygen saturation were significant predictors of surgical outcomes （P 〈0.05）.There was a significant correlation between the D-HM and the postoperative AHI （r =0.284,P =0.001）.The D-HM of ≥ 23 mm could predict the postoperative AHI of 〉 10 times/h a specificity of 95.2%.Conclusion The D-HM is a negative predictor of surgical outcomes,patients with a D-HM of ≥23 mm are inappropriate candidates for velopharryngeal surgery.